Circulatory disorders often develop in secret. High blood pressure, for example, hurts without pain. Even high cholesterol clogs the blood vessels without telling the brain. The consequences often become apparent only when vessels are so heavily blocked that the flow of blood ceases and the heart or brain is no longer adequately supplied with oxygen.
The consequences of such cardiovascular diseases are among the most common complaints worldwide. In 2015 alone, an estimated 422.7 million people contracted the heart and circulation, and nearly 18 million died.
This could often be prevented - not only by a different lifestyle, but also by medication: Already more than 15 years ago researchers developed for the first time a cheap pill, which is also antihypertensive and cholesterol-lowering and contains the blood-thinning aspirin. Applied to all people 55 and older, the pill could reduce cardiovascular disease by more than 80 percent, according to a 2001 model calculation. In reality, however, such a drug has never been tested in a large group for a long time.
Now researchers have closed this gap a bit. In their study in more than 200 villages in Iran, they showed that such a polyp can actually reduce the risk of serious cardiovascular disease - albeit not by 80 percent.
Eat healthier, smoke less, swallow pill
More than 6800 people participated in the study, and their ages ranged from 50 to 75 years. Only 90 percent had cardiovascular disease at the beginning of the study, the scientists around Reza Malekzadeh of the Tehran University of Medical Sciences write in the journal "The Lancet". At random, they divided the participants in the village group into two groups:
- Half of them received only health information, such as the benefits of low-salt diets, sugars and fats, and the risks of smoking and consuming opium - a common habit in the region.
- The remaining participants received the same information, but in addition they got a pill with four ingredients, which they should take once a day. The drug was composed of aspirin, two widely used antihypertensives, and an agent designed to reduce blood cholesterol.
The investigation ran for a total of five years. During this time, the researchers documented how often the participants developed severe cardiovascular diseases such as heart attacks or strokes. There were clear differences between the groups: While 8.8 percent of the participants without a pill seriously fell ill, it was 5.9 percent among tablet chewers - one third less. Thus, around 35 participants had to be given the pill to prevent severe cardiovascular disease.
The effect was even more pronounced when the researchers looked only at the participants who regularly swallowed the pill until the end. In this subgroup - around 63 percent of the pills group - only four percent fell ill within the five years. The risk of severe cardiovascular disease was thus more than half lower than in the non-pills group.
And what about side effects?
What astonished: Although the cholesterol levels in the pills recipients declined slightly more than in the other group, the blood pressure values remained similar. One reason for this could be that all participants - regardless of which group - were treated for high blood pressure. No one was denied therapy. The observed, more rare cardiovascular diseases in the pills group are therefore probably attributable mainly to the aspirin contained and not the antihypertensive, the researchers write the study.
more on the subject
However, the idea of treating entire groups of the population as of a certain age as a preventative measure also has a major disadvantage. It implies that even perfectly healthy people swallow medication and expose themselves to the risk of side effects. For example, aspirin permanently increases the risk of stomach bleeding. However, at least during the five-year study period, researchers were unable to observe any serious side effects.
It makes sense to use the pill, especially in emerging and developing countries, which have no close-knit health care and in which the number of people with heart disease is increasing. There, a widely available, affordable polyp can improve access to essential drugs - and thus significantly reduce the consequences of cardiovascular disease, says the accompanying "Lancet" comment.
In fact, the United Nations has set its sustainability goals to reduce the number of premature deaths from cardiovascular disease by one third by 2030. Most emerging and developing countries will miss this target, the researchers write.